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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881480
Report Date: 08/10/2025
Date Signed: 08/10/2025 04:30:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/23/2024 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240723134829
FACILITY NAME:ARLINGTON RIVERSIDE SENIOR COMMUNITYFACILITY NUMBER:
331881480
ADMINISTRATOR:WILLIAMS, MORGANFACILITY TYPE:
740
ADDRESS:4609 ARLINGTON AVETELEPHONE:
(951) 462-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:232CENSUS: 96DATE:
08/10/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Wellness Coordinator Breanna JonesTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff failed to provide supervision to resident in care
Staff failed to assist a resident in care with toileting
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Wellness coordinator Breanna Jones and explained the purpose of the visit. Administrator Molly Bowie arrived shortly.

The investigation consisted of the following: During the initial visit conducted on 07/25/2025, LPA Martinez conducted a tour of the interior/exterior areas of the facility, conducted interviews, and obtained copies of pertinent documentation. On todays visit LPA Gutierrez interviewed Administrator, Staff #1- Staff #6, and Residents #2 -Residents #9. LPA obtained copies of the following documents: staff roster, resident roster, R1’s admission agreement and physicians report will be emailed to LPA. During today’s visit LPA Gutierrez delivered findings.

SEE 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20240723134829
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ARLINGTON RIVERSIDE SENIOR COMMUNITY
FACILITY NUMBER: 331881480
VISIT DATE: 08/10/2025
NARRATIVE
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In regard to the allegation “Facility staff failed to provide supervision to resident in care”, it is alleged that staff “walked off” leaving resident needing help with using the restroom. During interviews with Administrator and staff seven (7) out of seven (7) stated that to their knowledge no staff has ever walked out on a client needing assistance with using the restroom. Staff stated they felt there was enough staff to provide supervision to residents in need. During interviews with residents eight (8) out of nine (9) residents stated no staff has ever walked out on them however they do feel more staff is needed.

In regard to the allegation “Staff failed to assist a resident in care with toileting”, it is alleged that resident was left in soiled clothes for multiple days. During interviews with Administrator and staff seven (7) out of seven (7) stated that they have never had a resident left in soiled clothes for multiple days. Staff stated that if a resident had incontinent care needs that they are checked on every two hours or more if needed. During interviews with residents six (6) out of nine (9) residents stated that they have never been left or witnessed any one being left in solid clothes. R2 stated that he/she does have incontinence care and is checked up on every 2 hrs.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was given.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2